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Medical: 5

Cardiology: 2 ════════════════════════════════════════════════════════════════════════════════════ ══════════════════════════

      • b.

        Irregular rhythm

        • (1)

          ECG strip method

        • (2)

          "300" method

  • E.

    Lead systems and heart surfaces

    • 1.

      ECG rhythm analysis

      • a.

        Value

      • b.

        Limitations

    • 2.

      Heart surfaces

      • a.

        Inferior

      • b.

        Left lateral

      • c.

        Precordial

    • 3.

      Acute signs of ischemia, injury and necrosis

      • a.

        Rationale

        • (1)

          Possible early identification of patients with acute myocardial infarction for intervention (thrombolysis or PTCA)

        • (2)

          The role of out-of-hospital twelve-lead ECG is still unresolved and may not be appropriate in many EMS settings

        • (3)

          EMS medical directors will make decisions regarding the application and use of the 12-lead ECG in their specific EMS setting

      • b.

        Advantages/ disadvantages

      • c.

        ST segment elevation

        • (1)

          Height, depth and contour

        • (2)

          ST (acute changes)

          • (a)

            Anterior wall

            • i)

              Significant ST elevation in V1- V4 may indicate anterior involvement

          • (b)

            Inferior wall

            • i)

              Significant ST elevation in II, III and aVF may indicate inferior involvement

        • (3)

          ST segment depression in eight or more leads

        • (4)

          ST segment elevation in aVR and V1

      • d.

        Q waves

        • (1)

          Depth, duration and significance

          • (a)

            Greater than 5 mm, greater than .04 seconds

          • (b)

            May indicate necrosis

          • (c)

            May indicate extensive transient ischemia

  • F.

    Cardiac arrhythmias

    • 1.

      Approach to analysis

      • a.

        P wave

        • (1)

          Configuration

        • (2)

          Duration

        • (3)

          Atrial rate and rhythm

      • b.

        P-R (P-Q) interval

        • (1)

          Duration

      • c.

        QRS complex

        • (1)

          Configuration

        • (2)

          Duration

        • (3)

          Ventricular rate and rhythm

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────────────────────────── United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum

15

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